Lansing M B, Glaser B M, Liss H, Hanham A, Thompson J T, Sjaarda R N, Gordon A J
Retina Center, Saint Joseph Hospital, Baltimore, MD 21284-0000.
Ophthalmology. 1993 Jun;100(6):868-71; discussion 871-2. doi: 10.1016/s0161-6420(93)31561-7.
Surgical techniques for the treatment of macular holes generally include removal of the overlying cortical vitreous and/or epiretinal membranes. The authors demonstrate that by using vitrectomy, posterior hyaloid removal, fluid-gas exchange, and transforming growth factor-beta 2 (TGF-beta 2), a growth factor that modulates the wound healing process, epiretinal membrane peeling can be avoided and the surgical procedure thereby simplified without compromising results.
A total of 24 eyes of 24 patients with stage 2, 3, or 4 full-thickness macular holes were treated. Of 24 patients, 1 was lost to follow-up after suffering a stroke; the remaining 23 (17 females and 6 males) (age range, 11-81 years; mean, 64 years) were followed for 5 to 16 months (mean, 12 months). Preoperative best-corrected visual acuity ranged from 20/50 to 20/400 (mean, 20/125). A standardized vitrectomy was performed with posterior hyaloid removal and, after a near-complete fluid-air exchange, 0.1 ml of a solution containing 1330 ng of TGF-beta 2 was instilled over the macular hole. No attempts were made to peel epiretinal membranes or drain fluid from the macular hole.
Of 23 eyes, 22 (96%) had resolution of the surrounding subretinal fluid and flattening of the macular hole (1 patient required a second procedure, in which visual improvement of 20/30 was achieved); 11 (48%) had visual acuities of 20/40 or better, 19 (85%) had visual acuities of 20/60 or better, and 19 (85%) showed an improvement in visual acuity of at least two lines (mean, 3.8 lines). The authors saw no retinal pigment epithelial mottling.
The authors' results demonstrate that treatment of macular holes using vitrectomy, fluid-gas exchange, and the instillation of a solution containing TGF-beta 2, without epiretinal membrane peeling, maintains efficacy while simplifying surgery.
黄斑裂孔的手术治疗技术通常包括切除覆盖其上的皮质玻璃体和/或视网膜前膜。作者证明，通过玻璃体切除术、去除后玻璃体皮质、液 - 气交换以及使用转化生长因子 - β2（TGF - β2，一种调节伤口愈合过程的生长因子），可以避免视网膜前膜剥除，从而简化手术过程且不影响手术效果。
对24例患有2期、3期或4期全层黄斑裂孔的患者的24只眼进行治疗。24例患者中，1例在中风后失访；其余23例（17例女性和6例男性）（年龄范围11 - 81岁；平均64岁）随访5至16个月（平均12个月）。术前最佳矫正视力范围为20/50至20/400（平均20/125）。进行标准化玻璃体切除术并去除后玻璃体皮质，在近乎完全的液 - 气交换后，将0.1 ml含1330 ng TGF - β2的溶液滴注在黄斑裂孔上。未尝试剥除视网膜前膜或从黄斑裂孔引流液体。
23只眼中，22只（96%）视网膜下液吸收且黄斑裂孔变平（1例患者需要二次手术，术后视力提高到20/30）；11只（48%）视力达到20/40或更好，19只（85%）视力达到20/60或更好，19只（85%）视力至少提高两行（平均3.8行）。作者未观察到视网膜色素上皮斑驳。
作者的结果表明，使用玻璃体切除术、液 - 气交换以及滴注含TGF - β2的溶液治疗黄斑裂孔，不进行视网膜前膜剥除，在简化手术的同时保持了疗效。
